Spontaneous regression of lumbar disc herniation: four cases report and review of the literature.

Spontaneous regression of lumbar disc herniation refers to shrinkage or disappearance of herniated nucleus pulposus without invasive surgical treatments. This phenomenon has been reported and is supported by improved clinical symptoms and radiographic after conservative treatment, but the underlying mechanism remains unclear. This article reports 4 cases of disc reabsorption and reviews the distribution of several clinical and radiographic factors of disc herniation reabsorption of total 46 patients, including the four from our study, gathered from 28 recent publications. Some of these factors are present with anomalous distributions. But some factors have similar deviations in patients with lumbar disc herniation. Therefore, more research is needed to explore the correlation between those factors and disc reabsorption.

Clinical, radiographic and biochemical assessment of proximal cavities restored with composite resin using incremental vs. bulk packing techniques: One-year randomized clinical trial.

BACKGROUND: Bulk-fill resin composites may suffer from recurrent caries around compound proximal restorations in posterior teeth, especially at the proximo-gingival interface.Over 12 months, will the bulk fill technique affect the caries recurrence rate at gingival margins when compared to the conventional incremental packing technique? How early will the first clinical, radiographical, and biochemical evidence of caries recurrence occur? METHODS: After randomization, in 30 patients with two compound (OM or OD) supragingival lesions, one tooth was restored using the bulk fill technique on one side (group 1) (n = 15). In contrast, the other tooth on the other side was restored utilizing the incremental layering technique (group 2) (n = 15). Both teeth received restorative material (X-tra fil, Voco, Cuxhaven, Germany). The FDI criteria were used to evaluate restorations. As for the periodontal assessment, the gingival index, plaque index, papillary bleeding scoring index and periodontal pocket depth were evaluated. The gingival crevicular fluid (GCF) specimens were gathered, and MMP-9 was extracted and quantitated by ELISA. A customized radiographic template was designed, and 3D printed digital bitewing radiographs were taken. Assessments were done clinically, radiographically and biochemically at baseline (1 week) and after 3, 6 and 12 months. Data was statistically analyzed. RESULTS: The null hypothesis was accepted clinically; no statistically significant differences appeared between bulk and incrementally filled posterior restorations. As for the radiographic assessment, the null hypothesis was accepted except for increased periodontal ligament width at 3 months. The null hypothesis for the biochemical evaluation was rejected as there were significant changes in levels of MMP-9 at different testing times. CONCLUSIONS: 1. With similar results but less sensitivity and significant time saving, the bulk fill technique can be considered an efficient alternative to the incremental fill technique in restoring proximal cavities. 2. Early evidence of caries recurrence can be correlated to an increase in the MMP-9 level in gingival crevicular fluid, followed by an increase in radiographic periodontal ligament width measurement. TRIAL REGISTRATION: An ethical approval from the Research Ethics Committee at the Faculty of Dentistry, October 6 University, (Approval No. RECO6U/5-2022). The study was registered at the Pan African Clinical Trials Registry on 24/07/2023 with an identification number (PACTR202307573531455).

A radiographic artificial intelligence tool to identify candidates suitable for partial knee arthroplasty.

INTRODUCTION: Knee osteoarthritis is a prevalent condition frequently necessitating knee replacement surgery, with demand projected to rise substantially. Partial knee arthroplasty (PKA) offers advantages over total knee arthroplasty (TKA), yet its utilisation remains low despite guidance recommending consideration alongside TKA in shared decision making. Radiographic decision aids exist but are underutilised due to clinician time constraints. MATERIALS AND METHODS: This research develops a novel radiographic artificial intelligence (AI) tool using a dataset of knee radiographs and a panel of expert orthopaedic surgeons' assessments. Six AI models were trained to identify PKA candidacy. RESULTS: 1241 labelled four-view radiograph series were included. Models achieved statistically significant accuracies above random assignment, with EfficientNet-ES demonstrating the highest performance (AUC 95%, F1 score 83% and accuracy 80%). CONCLUSIONS: The AI decision tool shows promise in identifying PKA candidates, potentially addressing underutilisation of this procedure. Its integration into clinical practice could enhance shared decision making and improve patient outcomes. Further validation and implementation studies are warranted to assess real-world utility and impact.

Analysis of palatal rugae pattern and maxillary sinus index for gender determination.

Correlation between rugoscopy and lateral cephalometric radiographic technique for gender determination is of interest. A cross sectional study was conducted on 100 subjects within an age group of 20 to 50 years. Distribution of rugae patterns and morphometric analysis of maxillary sinus was done for gender correlation. Wavy curved and straight rugae patterns were observed to be more in female gender as compared to males. The mean MSI was higher in females (1.32) when compared with males (1.26). Both the morphometric analysis of maxillary sinus and rugoscopy has been proved to be a valuable tool in the assessment of sexual dimorphism. But, morphometric analysis of maxillary sinus is relatively a new and reliable method for gender determination using maxillary sinus index.

Clinical course and radiographic resolution of pneumonia in dogs treated with a shorter versus longer course of antimicrobials: a randomized, double-masked, placebo-controlled study.

OBJECTIVE: To describe clinical and radiographic outcomes in dogs with uncomplicated pneumonia receiving a shorter (2-week) versus longer (4-week) duration of antimicrobial therapy. ANIMALS: 30 client-owned dogs with radiographic evidence of pneumonia. METHODS: Dogs were randomly assigned to either a 2-week course of antimicrobials followed by a 2-week course of placebo medication (2-week group) or a 4-week course of antimicrobials (4-week group). All study investigators and owners were masked to the treatment group. Dogs were reevaluated at 12 ± 2 days and again at 28 ± 2 days for a physical examination and thoracic radiography. Standard documentation at visits included owner-reported clinical signs, nurse-acquired history, the clinician's physical examination, the number of affected lung lobe segments, and the global radiographic severity scores assigned. Outcomes investigated included the persistence of clinical and radiographic signs of pneumonia. RESULTS: 28 dogs (93.3%) experienced complete resolution of clinical signs by the first visit, and no dogs in either group experienced relapse of clinical signs during the study period. Eighteen of 30 dogs (60%) and 25 of 30 dogs (83%) experienced complete resolution of radiographic lesions at the first and second study visits, respectively. The remaining 5 dogs (17%) had either stable (4 dogs) or continued (1 dog) improvement in radiographic lesions. CLINICALCLINICAL RELEVANCE: Resolution of clinical and radiographic signs followed similar courses in dogs with uncomplicated pneumonia receiving a 2-week course of antimicrobials compared to a 4-week course. Clinical signs may be more useful for guiding discontinuation of antimicrobial therapy for pneumonia than radiographic signs.

Treatment strategies for Spondyloarthritis: Implementation of precision medicine - Or "one size fits all" concept?

Spondyloarthritis (SpA) is a term to describe a group of chronic inflammatory rheumatic diseases, which have common pathophysiological, genetic, and clinical features. Under the umbrella term SpA, two main groups are subsumed: axial SpA (radiographic axSpA and non-radiographic axSpA) and peripheral SpA (with the leading representative being psoriatic arthritis (PsA) but also arthritis associated with inflammatory bowel disease (IBD), reactive arthritis, and undifferentiated pSpA). The key clinical symptom in axSpA is chronic back pain, typically with inflammatory characteristics, which starts in early adulthood, while the leading clinical manifestations of peripheral SpA (pSpA) are arthritis, enthesitis, and/or dactylitis. Furthermore, extra-musculoskeletal manifestations (EMMs) (acute anterior uveitis, psoriasis, and IBD) can accompany axial or peripheral symptoms. All these factors need to be taken into account when making treatment decisions in SpA patients. Despite the major advances in the treatment landscape over the past two decades with the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and most recently targeted synthetic DMARDs (tsDMARDs), a relevant proportion of patients still does not achieve the desired state of remission (=absence of disease activity). With this implementation of new treatment modalities, clinicians now have more choices to make in the treatment algorithms. However, despite generalized treatment recommendations, all factors need to be carefully considered when deciding on the optimal treatment strategy for an individual patient in clinical practice, aiming at an important first step towards personalized treatment strategies in SpA. In this narrative review, we focus on the efficacy of approved and emerging treatment options in axSpA and PsA as the main representative of pSpA and discuss their selective effect on the different manifestations associated with SpA to provide guidance on drivers of treatment decisions in specific situations.

Pseudoprogression Following Liver Stereotactic Body Radiotherapy (SBRT) in a Patient With Oligometastatic Leiomyosarcoma: A Case Report.

Stereotactic body radiotherapy (SBRT) is a non-invasive form of radiation that has been utilized for oligometastatic malignancies. However, pseudoprogression is a common radiological occurrence following this treatment, which manifests as an increase in tumor size before its reduction. We discuss a case of a 58-year-old female patient who initially presented with uterine leiomyosarcoma. Following surgery and postoperative radiation, she was later found to have solitary liver metastasis after three years of surveillance, which was managed by SBRT. However, on short-term follow-up, the lesion was found to have increased in size, prompting discussion regarding whether the growth was a progression of disease or a secondary effect of treatment. After close follow-up, the tumor continued to shrink until it was no longer visible on imaging. This is the first report discussing pseudoprogression following SBRT in a retroperitoneal leiomyosarcoma patient. It serves as a reminder for clinicians to consider the possibility of pseudoprogression before the failure of therapy.

Hallux valgus and pes planus: Correlation analysis using deep learning-assisted radiographic angle measurements.

BACKGROUND: The relationship between hallux valgus (HV) and pes planus remains unresolved. This study aims to determine the correlation between HV and pes planus using a deep learning (DL) model to measure radiographic angle parameters. METHODS: In total, radiographs of 212 feet detectable by the DL model were analyzed. HV was evaluated using the hallux valgus and intermetatarsal angles, while pes planus was assessed using the lateral talo-first metatarsal (Meary's) and calcaneal pitch angles. Correlation analyses were performed for each DL model-measured angle parameter. We investigated whether pes planus worsened with increasing severity of HV and vice versa. RESULTS: All parameters were significantly correlated with each other. Pes planus worsened with increasing severity of HV, and as the severity of pes planus increased, HV also worsened. CONCLUSION: Utilizing the DL model-assisted radiographic angle measurements, this study established a significant correlation between HV and pes planus. LEVEL OF EVIDENCE: III.

Evaluation of measurements for tracheal hypoplasia in French bulldogs.

Tracheal narrowing may increase airflow resistance, resulting in clinical manifestations associated with brachycephalic obstructive airway syndrome (BOAS). When diagnosing tracheal hypoplasia, established values are based on measurements established for English bulldogs or non-specific "bulldog" breeds. The objective of this study was to investigate tracheal diameter ratios in French bulldogs to gain a better understanding of what would constitute tracheal hypoplasia in this breed. A retrospective observational analysis was conducted to measure the right lateral thoracic radiographs of 139 French bulldogs to investigate tracheal diameter ratios. Pulmonary disease was observed in 55/139 dogs. The mean TD:Ti for healthy French bulldogs was 0.15 (±0.02), and the mean TD:ML was 0.32 (±0.07). 44/84 dogs had a TD:Ti < 0.15 (±0.02), and 37/65 dogs had a TD:ML < 0.32 (±0.07). At least one thoracic vertebral anomaly was observed in 131/139 of evaluated French bulldogs, and sternal malformations were observed in 42/139 dogs. TD:ML showed an excellent interclass correlation between observers (ICCinter 0.9562). The listed covariables were compared for statistical significance when measuring relative tracheal ratios, and none were found. There was a statistically significant relationship between TD:Ti and sex. An objective value for tracheal hypoplasia in French bulldogs has previously not been established. The mean TD:Ti described for French bulldogs in this study is higher than that previously described in other "bulldog" populations. The mean TD:ML is similar to previously reported for non-brachycephalic and non-bulldog brachycephalic small breed dogs. The correlative relationship between TD:Ti and TD:ML was statistically significant but weak.

Stress shielding in stemmed reverse shoulder arthroplasty: an updated review.

BACKGROUND: Reverse shoulder arthroplasty (RSA) is popular for the treatment of degenerative glenohumeral joint disease. Bone remodeling around the humeral stem related to stress shielding (SS) has been described. This review focuses on the specific radiological characteristics, risk factors, and clinical consequences of SS in RSA. METHODS: A meticulous review was conducted of articles published between 2013 and 2023. Data on the definition, risk factors, and clinical impact of stress shielding were recorded. RESULTS: Twenty-eight studies describing 2691 patients who had undergone RSA were included. The mean age of patients ranged from 63 to 80 years with mean follow-up periods of 12 months to 9.6 years. The prevalence of SS reached up to 39% at a 2-year follow-up. Females and elderly are typically at higher risk due to osteopenia. SS was more frequent with the use of long stems(>100 mm) compared to short stems(<100 mm). Stem design, onlay or inlay, and neck-shaft-angle did not influence SS. Frontal misalignment and a high filling ratio are riskfactors for SS. Biological factors also contribute to SS, associated with scapular notching. No correlation was found between SS and clinical outcomes. CONCLUSIONS: SS is common in patients with cementless implants after RSA, especially in female and elderly patients. It can be limited by implanting stems with a low diaphyseal filling-ratio, in correct coronal alignment. Risk factors for polyethylene debris, primarily scapular notching, should be avoided. The authors found no clinical consequences of stress shielding, but longer-term follow-up studies are required to confirm these findings.

Assessment of Thoracic Radiographic Alterations in Dogs with Heartworm and Their Correlation with Pulmonary Hypertension, Pre- and Post-Adulticide Treatment.

Pulmonary hypertension (PH) is a prevalent and severe complication in dogs infected with Dirofilaria immitis. This study aimed to elucidate the progression of PH by analyzing radiographic parameters and the Right Pulmonary Artery Distensibility (RPAD) Index at three key time points: diagnosis (day 0), discharge (day 90), and six months post-discharge (day 270). Fifty-two heartworm-infected dogs were divided into two groups: non-hypertensive and hypertensive. Radiographic measurements, including Vertebral Heart Size (VHS), CrPA/R4 ratio, and CdPA/R9 ratio, along with the RPAD Index, were assessed on Days 0, 90, and 270. Results indicated that, in Group A, the RPAD Index improved significantly from 42% on Day 0 to 43.16% on Day 90, with no significant change by Day 270 (42%). In contrast, hypertensive dogs exhibited a persistently low RPAD Index, averaging 17% throughout this study (p < 0.001). Radiographic parameters in hypertensive dogs showed continuous elevation compared to non-hypertensive dogs, with significant increases in VHS, CrPA/R4, and CdPA/R9 ratios on day 270 compared to day 0 (p < 0.05). The results confirmed that PH persisted in dogs with D. immitis after adulticide treatment, highlighting the importance of regular radiographic monitoring for assessing and managing long-term outcomes in dogs with PH during and after adulticide treatment. Continuous surveillance is thus essential for the effective post-treatment management of PH in dogs.

Assessment of Periodontitis Risk Factors in Endodontically Treated Teeth: A Cross-Sectional Study.

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

[Standard radiographic images in cephalomedullary nailing fixation for intertrochanteric femoral fractures].

Objective: To review and summarize the projections of radiographic images during cephalomedullary nailing fixation for intertrochanteric femoral fractures, and to propose a set of three projections as standard requirement in immediate postoperative fluoroscopy. Methods: Papers on intertrochanteric femoral fractures treated with cephalomedullary nailing fixation that published in a three-year period of 2021-2023 in four leading English orthopedic trauma journals were searched in PubMed. The presented radiographic pictures were identified and scrutinized as whether they were in standard anteroposterior and/or lateral projections of the implanted nails. The nonstandard presence percentage was calculated. Combined with clinical experience, the standard anteroposterior and lateral perspective images of femoral neck, the current situation of radiographic imaging in the operation of cephalomedullary nails, the literature analysis of nonstandard images, the impact of limb rotation on image interpretation, and the characteristics of anteromedial 30° oblique perspective were summarized and analyzed. Results: The presence of nonstandard radiographic pictures is 32.1% in anteroposterior view and 69.2% in lateral view in leading orthopedic trauma journals. In cephalomedullary nailing fixation operation of intertrochanteric femoral fractures, it is reasonable to use the radiographic images of the implanted nails to represent the fractured head-neck, as the head-neck implant (lag screw or helical blade) is aimed to put into centrally in femoral head in lateral projection. Limb rotation or nonstandard projections produced distortion of images, which interfers the surgeons' judgement of fracture reduction quality and the measurement of implant position parameters in femoral head (such as neck-shaft angle and tip-apex distance), and finally lead to a meaningless comparison with the accurate normal value. The 30° anteromedial oblique view from the true lateral (set as 0°) is a tangential projection of the cortices at the anteromedial inferior corner, which gives a clear profile for the determination of cortical apposition status and mechanical support. It is essential to get firstly the true standard lateral fluoroscopy of the nail (shown as a line), then rotate the C-arm to 90° and 30° to get anteroposterior and anteromedial oblique views, and use these three immediate postoperative radiographies as the baseline for evaluation of operative quality and follow-up comparisons. Conclusion: As for real-time monitoring of surgical steps, intraoperative fluoroscopy follows the "Enough is Good" principle, but as for immediate postoperative data storage and basis for operative quality evaluation and baseline for follow-up comparison, it is recommended to obtain a set of three standard radiographic pictures in anteroposterior, true lateral, and 30° anteromedial oblique fluoroscopic projections.

Expandable versus Static Transforaminal Lumbar Interbody Fusion (TLIF) Cages: Comparing Radiographic Outcomes and Complication Profiles.

BACKGROUND CONTEXT: Expandable Transforaminal Lumbar Interbody Fusion (TLIF) cages have become popular in recent years due to anticipated advantages of increased disc height, improved segmental lordosis, and ease of implantation. Such benefits have not been conclusively demonstrated in the literature. PURPOSE: To determine whether expandable cages increase disc height and segmental lordosis in a durable way following surgery and compare complication profiles between cage types. STUDY DESIGN/SETTING: Retrospective cohort study conducted within a large academic health system involving 31 different spine surgeons. PATIENT SAMPLE: Adults undergoing single-level TLIF for an indication other than infection, tumor, trauma, or revision instrumentation from 2021-2023. OUTCOME MEASURES: Our primary outcomes were changes in segmental disc height, segmental lordosis, and L4-S1 lordosis at 2 weeks, 6 months, and 1 year following surgery relative to baseline. Our secondary outcomes were frequencies of incidental durotomies, surgical site infections, readmissions, death, subsidence, and unplanned return to the operating room. METHODS: Radiographic variables were collected from our institutional imaging registry. Demographics and surgical characteristics were abstracted from chart review. Generalized linear modeling was used for each primary outcome, with cage type (expandable versus static) as our primary predictor and age, biologic sex, race, CCI, year of surgery, duration of surgery, invasiveness of surgery, surgeon specialty (Orthopaedics versus Neurosurgery), and level of surgery as covariates. RESULTS: Our cohort consisted of 417 patients with a mean age of 62. Static cages were used in 306 patients and expandable cages in 111. Expandable cages were associated with increased changes in disc height relative to static cages at 2 weeks (1.1 mm [0.2-1.9]; p=0.01) and 6 months (1.2 mm [0.2-2.3]; p=0.02) following surgery, but differences were no longer significant at 1 year (0.4 mm [-0.9-1.8]; p=0.4). Expandable cages were found to subside more commonly than static cages (14.1% vs 6.6%; p=0.04). No differences between cage types were identified in lordotic parameters at any timepoint (p=0.25-0.97). CONCLUSIONS: Expandable cages were associated with an initial increase in disc height relative to static cages, but this difference diminished with the first year of surgery, likely due to a higher rate of subsidence within the expandable cohort.

The influence of miscentering on radiation dose during computed tomography head examinations and the role of localiser orientation: A phantom study.

INTRODUCTION: Computed Tomography (CT) chest, abdomen and pelvis research demonstrates a relationship between vertical phantom positioning and radiation dose. Moving the phantom closer or further from the x-ray source results in magnification or minimisation of the localiser. As automatic tube current modulation (ATCM) algorithms use localisers to estimate patient size and calculate required tube current, magnification or minimisation results in the incorrect provision of radiation dose. Radiation dose changes also depend on localiser orientation, changes with anteroposterior (AP) and posteroanterior (PA) localisers demonstrating an inverse relationship. However, within CT head literature often attributes radiation dose changes on impaired function of the bow-tie filter instead. The current study investigated the role of miscentering on ATCM function within CT head, paying particular attention to localiser orientation. METHODS: Head scanning was performed with an anthropomorphic phantom at the isocentre, alongside ten vertically miscentered positions. This was performed three times, with an AP, PA and lateral localiser. CT dose index values at each miscentered level were compared across conditions. RESULTS: Vertical miscentering altered radiation dose in both AP and PA conditions, radiation dose linearly increasing (up to 17.05%) when positioning the phantom closer to the x-ray source and decreasing when positioning away (up to -13.13%). Changes across AP and PA conditions demonstrated an inverse relationship. Radiation dose was unaffected in the lateral condition. CONCLUSIONS: Miscentering during CT head alters ATCM function due to magnification/minimisation of the localiser image, causing ATCM algorithms to misinterpret patient size and miscalculate required tube current. IMPLICATIONS FOR PRACTICE: Radiographers should be accurate when centering for CT head, avoiding any potential radiation dose changes. Further research into vertical miscentering and image quality during CT head is recommended.

Comment on, "Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up".

The article by Liu et al. (2024) investigates the progression of ossification of the posterior longitudinal ligament (OPLL) in 29 patients post-cervical laminoplasty. The study meticulously tracks transverse and longitudinal OPLL progression, providing crucial insights into surgical planning and patient outcomes. While the research design is commendable, reliance on X-ray imaging limits precision compared to CT or MRI scans. The sample size, though adequate for initial findings, may not fully capture OPLL variability, and the follow-up period could be extended to better assess long-term outcomes. Future studies should incorporate advanced imaging techniques, larger cohorts, and patient-reported outcomes to enhance the understanding of OPLL progression, thereby refining surgical strategies and improving personalized care for OPLL patients.

Corrigendum: Real-world experience with secukinumab in the entire axial spondyloarthritis spectrum.

[This corrects the article DOI: 10.3389/fmed.2023.1156557.].

Left Pubic Symphysis Fracture With Undiagnosed Ipsilateral Femoral Neck Fracture in an Elderly Female With Osteoporosis: A Case Report.

Femoral neck fractures are a common complication of falls, particularly in the osteoporotic elderly female population. This case highlights the significance of properly radiologically evaluating elderly patients with falls. A 68-year-old White female with paroxysmal atrial fibrillation on anticoagulation, nicotine use disorder, chronic hyponatremia, hypertension, and hyperlipidemia presented to the emergency department (ED) in considerable pain four days after a previously diagnosed left pubic symphysis fracture. Repeat imaging (X-ray and computed tomography (CT)) was significant for a left femoral neck fracture concurrent with the aforementioned pelvic fracture. Within 48 hours of admission, the patient underwent a hemiarthroplasty of the left hip. The postoperative course was unremarkable, except for immensely decreased pain and a remarkable ability to ambulate, and on postoperative day three, the patient was discharged. In patients with an overall high risk of hip fracture, CT imaging should be considered after X-ray in an effort to eliminate the frequency of undiagnosed fractures. It is essential to thoroughly evaluate the entire film, even after one fracture is found. This is crucial to a patient's overall well-being and can contribute to many unwanted phenomena.

Assessing the Efficacy: Mid-Term Clinical and Radiological Outcomes of the Comprehensive Short Stem System in Reverse Shoulder Arthroplasty.

BACKGROUND: For degenerative shoulder disease, reverse shoulder arthroplasty (RSA) has proven successful; however, problems such as scapular notching and instability still exist. These difficulties are intended to be addressed by recently improved prosthesis designs with reduced neck-shaft angles (NSA). Still, there are issues with complications, particularly with the humerus. In an effort to avoid these problems and maintain bone stock, a recently designed straight-short-stem humeral component was used; however, yet its clinical and radiological outcomes in RSA remain largely unexplored. MATERIAL AND METHODS: Using a 55mm straight short stem (Comprehensive Reverse Shoulder System; Zimmer Biomet), a retrospective analysis of 93 patients undergoing primary RSA was carried out. Clinical assessments, including scores and range of motion, were conducted both before and after surgery. Complications, bone adaptation, and stem alignment were all evaluated radiographically. Significant correlations between postoperative shoulder movements and function were linked with angles of prosthesis lateralization and distalization. RESULTS: Patients demonstrated significant improvements in clinical scores at 35-month follow-up on average: Constant-Murley (76.4 ± 13.4), ASES (84.8 ± 16.5), DASH (17.1 ± 15.8), and UCLA (7.1 ± 1.5). Radiographic assessments showed no stem loosening and stable implant attachment. There was no scapular notching, and there were noticeable improvements in shoulder range of motion and function. DISCUSSION AND CONCLUSION: This study validates the efficacy of a straight short stem for acceptable clinical outcomes and implant stability in RSA. Notably, it demonstrates specific angle ranges crucial for optimal post-surgical shoulder function. The findings suggest this stem design presents potential benefits in RSA, highlighting its safety and effectiveness while providing insights for future clinical strategies. The study contributes valuable data toward understanding and enhancing patient outcomes in shoulder arthroplasty procedures.

Radiographic scores as a predictor of oxygenation index in very low-birthweight infants.

BACKGROUND: Very low birthweight infants (VLBWIs) often undergo chest radiographic examinations without standardization or objectivity. This study aimed to assess the association of two radiographic scores, the Brixia and radiographic assessment of lung edema (RALE), with oxygenation index (OI) in ventilated VLBWIs and to determine the optimal cutoff values to predict hypoxic respiratory severity. METHODS: VLBWIs who received invasive respiratory support with arterial lines between January 2010 and October 2023 were enrolled in this study (n = 144). The correlation between the Brixia or RALE scores and OI was investigated. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff points of the two radiographic scores for predicting OI values (OI ≥5, ≥10, and ≥15). RESULTS: The enrolled infants had a median gestational age of 27 weeks (interquartile range [IQR], 25-28 weeks) and a median birthweight of 855 g (IQR, 684-1003 g). Radiographic scoring methods correlated with the OI (Brixia score: r = 0.79, p < 0.001; RALE score: r = 0.72, p < 0.001). The optimal cutoff points for predicting OI values were as follows: Brixia score: OI ≥5, 10; OI ≥10, 13; OI ≥15, 15; RALE score: OI ≥5, 22; OI ≥10, 31; and OI ≥15, 40. CONCLUSIONS: Brixia and RALE scores are useful predictive markers of the oxygenation status in intubated VLBWIs with stable hemodynamics. These scores are easy to use and promising tools for clinicians to identify patients with a higher risk of hypoxic respiratory failure.